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The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma

The Clinical Application of Tumor Treating Fields Therapy in Glioblastoma

Published on: April 16, 2019

Tumor-Treating Field Arrays Do Not Reduce Target Volume Coverage for Glioblastoma Radiation Therapy.

Gregory C Stachelek¹, Jimm Grimm¹, Joseph Moore¹

¹Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, Maryland.

Advances in Radiation Oncology

|February 14, 2020

Summary

Tumor-treating field arrays (TTFields) placement minimally impacts glioblastoma radiation therapy target coverage. Repositioning TTFields arrays further reduces dosimetric changes, supporting combined treatment protocols.

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Area of Science:

Radiation oncology
Medical physics
Neurosurgery

Background:

Glioblastoma multiforme (GBM) is an aggressive brain tumor with limited treatment options.
Tumor-treating fields (TTFields) therapy is a recognized treatment modality for GBM.
Integrating TTFields with radiation therapy requires understanding potential dosimetric impacts.

Purpose of the Study:

To evaluate the dosimetric effects of TTFields array placement and repositioning on target volume coverage during glioblastoma radiation therapy.
To assess the impact of TTFields arrays on cranial skin dose.
To inform procedural development for combined TTFields and radiation therapy in GBM patients.

Main Methods:

Radiation plans for 10 glioblastoma patients were adapted to a cranial phantom.
TTFields arrays were placed in distinct positions on the phantom, and dose distributions were recalculated.
Planning target volume (PTV) coverage and skin dose were compared with and without TTFields arrays.
Percent depth dose curves were measured and compared to standard bolus materials.

Main Results:

TTFields arrays caused minor decreases in PTV coverage (V97%, D97%), which were mitigated by repositioning.
Averaging across three array positions, no statistically significant differences in PTV coverage (V95-97%, D95-97%) were observed compared to no arrays.
Mean increases in skin dose (D1cc, D20cc) were 3.1%, and surface dose under electrodes was less than with 5-mm superflab bolus.

Conclusions:

TTFields array placement does not significantly compromise target volume coverage in glioblastoma radiation therapy.
Array repositioning minimizes dosimetric changes, negating the need for replanning.
Observed skin dose increases are clinically insignificant, supporting the safety of combined TTFields and radiation therapy.